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    Is HPV Vaccine Benefit Exaggerated?

    Experts Debate Whether Gardasil Marketing Clouds Risk/Benefit Decision

    Gardasil Oversold by Medical Groups? continued...

    "There is very good evidence regarding the line leading from HPV infection to cancer," Haupt tells WebMD. "If you don't get infection with these cancer-causing strains of HPV, you don't get cervical cancer."

    Massad says the line between HPV infection and cervical cancer may be blurry -- but it's a line all the same.

    "Most women who get HPV are never at risk for cervical cancer -- but we don't have a way to tell who is and who is not at risk," Massad says. "It seems better to do widespread vaccination than not to take any action all."

    Haug says such an approach ignores the cost of the vaccine, and the risk of vaccination to women who might never get cervical cancer.

    HPV Vaccine, Pap Screens, and Cervical Cancer

    Rothman notes that whether or not women receive the vaccine, they still need regular Pap screening to look for early signs of cervical cancer. Screening cuts their risk of cervical cancer, and thus cuts the benefit of HPV vaccination.

    Haug notes that the U.S. women who get cervical cancer are those with the least access to health care. Those who get regular Pap tests, she says, are unlikely to get cervical cancer even if they don't get vaccinated against HPV.

    "We already have a way of preventing cervical cancer -- that is a major point, at least for those of us lucky enough to have health care and use it. So this can be prevented without the vaccine," Haug says.

    That's not entirely true, says Haupt.

    "While Pap screening is a very important intervention, it is not perfect. Not all women get Pap testing, and not all women who get Pap tests will have their lesions found," Haupt tells WebMD. "And even with 50 years of Pap testing, we see 30 cases of cervical cancer a day in the U.S. Vaccination is another tool that together with Pap screening will contribute to cancer prevention. Neither one works as well without the other."

    "We still have people dying of cervical cancer here in the U.S.," Englund says. "It is easy to say we can prevent cervical cancer with Pap screening, but people are not getting Pap screens: minority women, our native people, poorer people. So when you talk of risks and benefits, people must realize that some don't have the benefit of having the wonderful health care I enjoy because I have health insurance. But they still have the risk of cervical cancer."

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